Many hospitals have been slow to improve nurse staffing, even as evidence mounts that nursing resources are associated with better outcomes, including lower rates of patient mortality, avoidable complications, and readmissions. One barrier has been the cost of more and better trained nurses: are the benefits worth it? According to a new study by LDI Senior Fellows, the answer is a resounding yes.

The study, led by Karen Lasater, PhD, RN, confirmed that hospitals with better nursing resources achieved better outcomes for Medicare patients at no increased cost, even after accounting for additional nursing expenses. The researchers carefully matched 74,045 pairs of patients admitted for acute myocardial infarction, stroke, pneumonia, or congestive heart failure in 306 hospitals in four states. They defined better and worse nursing resourced hospitals by patient-to-nurse ratios, skill mix, proportions of bachelors-degree nurses, and nurse work environments. Patients in the better nursing resourced hospitals had 7% lower relative odds of 30-day mortality or 30-day readmission than matched patients in the worse nursing resourced hospitals.

*differences not statistically significant

Characteristics of better resourced hospitals

So what resources do better staffed hospitals bring to the table? On average, nurses in better nursing resourced hospitals cared for 1.5 fewer patients at a time (4.3 vs 5.8), had a richer skill mix of RNs to total nursing staff, had a greater proportion of nurses with at least a bachelor’s degree (67.5% vs 43.2%), and reported more favorable work environments, as compared to the worse nursing resourced hospitals.

Greatest benefits

The benefits of better nursing resourced hospitals were greatest in patients with sepsis and those who had the highest risk of mortality on admission. In fact, patients with sepsis had lower mortality in better nursing resourced hospitals at lower costs, even after adjusting for the additional costs of better nursing resources. These findings suggest that the quality effects of improved nursing matter most for high-risk seriously ill patients.

Prior literature made the quality case for better nursing clear. This study bolsters the economic case.  When hospitals invest in their nurses, patients benefit, with no net increase in costs. That’s a powerful value proposition.

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The study, Evaluating the Costs and Outcomes of Hospital Nursing Resources: a Matched Cohort Study of Patients with Common Medical Conditions, was published online in the Journal of General Internal Medicine on August 31, 2020. Authors include Karen B. Lasater, Matthew D. McHugh, Paul R. Rosenbaum, Linda H. Aiken, Herbert L. Smith, Joseph G. Reiter, Bijan A. Niknam, Alexander S. Hill, Lauren L. Hochman, Siddharth Jain, and Jeffrey H. Silber. The study was supported by the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing.